Provider Demographics
NPI:1407538812
Name:RAY, TEQUILIA YVETTE (FNP-BC)
Entity Type:Individual
Prefix:
First Name:TEQUILIA
Middle Name:YVETTE
Last Name:RAY
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:MS
Other - First Name:TEQUILIA
Other - Middle Name:YVETTE
Other - Last Name:RAY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:FNP-BC
Mailing Address - Street 1:76 CITADEL DR
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:GA
Mailing Address - Zip Code:30228-5999
Mailing Address - Country:US
Mailing Address - Phone:404-454-4273
Mailing Address - Fax:
Practice Address - Street 1:76 CITADEL DR
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:GA
Practice Address - Zip Code:30228-5999
Practice Address - Country:US
Practice Address - Phone:404-454-4273
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-04
Last Update Date:2023-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAF01230503363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily